Dementia currently affects 55 million people across the globe, and with ageing populations in developed nations, this is expected to increase by 10 million every year. Sounds insane right? What’s worse is that there is currently no cure for dementia, just medication to make symptoms slightly more manageable. With healthcare systems inadequately prepared for such an increase of dementia cases in future years, the burden placed on dementia caregivers is likely to increase. Thus, we must take a look at non-pharmacological treatments for dementia to provide effective support which,
improves patient independence and self-confidence, and
minimizes the burden placed on caregivers.
Many studies have shown the benefits of brain stimulation on dementia outcomes. Surgical brain stimulation, through Deep Brain Stimulation (DBS), may have positive effects on dementia patients. Although many trials have not yet been conducted to assess these effects, the surgical regulation of neuron activity could play a major role in dementia and other neurodegenerative-disorder treatment in the future. More accessible, however, are non-surgical brain stimulation treatments. One longitudinal study involving 469 elderly volunteers without dementia found that volunteers who frequently took part in challenging leisure activities (ie. reading, playing instruments, and dancing) were less likely to develop dementia than the volunteers who did not frequently participate in these activities. Interestingly, frequent journaling/other writing and taking part in group discussions did not show this preventative effect. From this we can see that only specific types of brain stimulation are actually effective in treating dementia.
Certain games have also been used to help improve memory in diagnosed dementia patients. Board games, such as chess and Jigsaw puzzles have already been used as accessible home care. In more recent years, researchers have looked at the effectiveness of video games (think Angry Birds) on dementia care. Some improvement in brain function was linked to such video games, however these traditional board/video games are not specific to dementia and therefore cannot act as targeted or legitimate dementia treatments.
This brings us to the topic of Serious Games Therapy. Serious games are defined as ‘games designed for a primary purpose other than pure entertainment’. In the world of neurodegenerative disorders, serious games should take into account the factors associated with cognitive decline, and also keep users stimulated. Tarraga et al. found that Alzhemier’s patients who received a multimedia, internet-based game treatment in combination with a psycho-stimulation treatment (IPP) (involving arts and music therapy) and a cholinesterase inihibitor treatment (ChEI) had a greater improvement in memory than patients who were given only IPP or only the ChEI treatment. This shows that Serious Game Therapy may enhance the effects of other traditional treatments, such as pharmacological and psycho-stimulation treatments, when used in combination.
Fig 1: Differences in ADAS-Cog (Alzheimer’s Disease Assessment Scale-Cognitive section) scores at 12 and 24 weeks from the start of the experimental, IPP, and ChEI treatments.
There are three main categories of serious games: board games, video games, and VR (virtual reality) games. It is important to note that board games and video games generally target cognitive impairment, while VR games target both cognitive and physical impairment.
Board Games
Board games such as checkers and abacus often involve memorization skills, deduction skills and communication with other players. These features may help dementia patients improve their emotional control and memory. Obviously, board games are the most easily accessible out of the three, but there are limitations to their practical use. For example, some high-strategy games are too difficult for dementia patients, and may cause some stress for the players. In addition, multiplayer games may be difficult to organize due to space, time, and caregiver requirements.
Video Games
Video games can be more easily adapted for dementia use, and customized for patient symptoms. Many researchers have implemented life skills (such as a budget gift-buying game), personal experiences (for example, an effective food stamp based game was created in China to emulate an experience of patients who grew up in the 1960s), and creative interests (such as music-themed games) into video games designed for dementia patients. These games are more stimulating due to visual and sound effects, but may not exercise communication skills the same way a multiplayer board game would.
VR Games
Hyper-realistic games could increase patient interactivity with dementia-care related activities, and have been shown to give improved performance. In one study by Manera et al, dementia patients were split into two groups: a paper-based image group and a VR-based image group. Both groups were asked to find a specific goal in the given image and the results showed a statistically significant decrease in the number of errors made and an increase in performance for the VR-based group compared to the paper-based group.
Researchers have proposed the use of different serious games for different symptoms in different dementia stages. Cognitive games like ‘NeuroRacer’ and ‘Pinball Recall’ target problem solving and memory attention, and can be used in early stage dementia. These skills help reduce the early stage symptoms of Mild Cognitive Impairment (MCI). Other games designed for use in this stage are used for ‘screening’, to help users differentiate between regular ageing symptoms and dementia.
On the other hand, serious games for middle stage dementia primarily focus on treatment rather than detection, and address both cognitive impairment and physical disorder. Examples for these games include ‘WiiFit’ and ‘Exergame’. Serious games are not suitable for late stage dementia, as patients in this stage may not be able to understand game rules or use motor functions.
With Alzheimer’s cases only rising in the future, it is important to consider alternative and combination treatment options. More studies should be conducted to determine the extent of effectiveness of Serious Game Therapy for dementia patients, specifically for use in early and middle stage dementia. Through the widespread adoption of Serious Game Therapy, we can provide symptom-specific, stage-targeted, and accessible dementia treatment which could benefit both patients and their caregivers.
References
“A Review on Serious Games for Dementia Care in Ageing Societies.” IEEE Journal of Translational Engineering in Health and Medicine, vol. 8, May 2020, p. 1400411. PubMed Central, https://doi.org/10.1109/JTEHM.2020.2998055.
Lv, Qing, et al. “Deep Brain Stimulation: A Potential Treatment for Dementia in Alzheimer’s Disease (AD) and Parkinson’s Disease Dementia (PDD).” Frontiers in Neuroscience, vol. 12, May 2018, p. 360. PubMed Central, https://doi.org/10.3389/fnins.2018.00360.
Serious Games - an Overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/engineering/serious-games. Accessed 24 July 2022.
Tong, Tiffany, et al. “Serious Games for Dementia.” Proceedings of the 26th International Conference on World Wide Web Companion, International World Wide Web Conferences Steering Committee, 2017, pp. 1111–15. ACM Digital Library, https://doi.org/10.1145/3041021.3054930.
Verghese, Joe, et al. “Leisure Activities and the Risk of Dementia in the Elderly.” New England Journal of Medicine, vol. 348, no. 25, June 2003, pp. 2508–16. Taylor and Francis+NEJM, https://doi.org/10.1056/NEJMoa022252.
Tárraga, L., et al. “A Randomised Pilot Study to Assess the Efficacy of an Interactive, Multimedia Tool of Cognitive Stimulation in Alzheimer’s Disease.” Journal of Neurology, Neurosurgery, and Psychiatry, vol. 77, no. 10, Oct. 2006, pp. 1116–21. PubMed, https://doi.org/10.1136/jnnp.2005.086074.
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